Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
Cost Eff Resour Alloc. 2011 Oct 6;9(1):14. doi: 10.1186/1478-7547-9-14.
Diabetes mellitus brings an increased risk for cardiovascular complications and patients profit from prevention. This prevention also suits the general population. The question arises what is a better strategy: target the general population or diabetes patients.
A mathematical programming model was developed to calculate optimal allocations for the Dutch population of the following interventions: smoking cessation support, diet and exercise to reduce overweight, statins, and medication to reduce blood pressure. Outcomes were total lifetime health care costs and QALYs. Budget sizes were varied and the division of resources between the general population and diabetes patients was assessed.
Full implementation of all interventions resulted in a gain of 560,000 QALY at a cost of €640 per capita, about €12,900 per QALY on average. The large majority of these QALY gains could be obtained at incremental costs below €20,000 per QALY. Low or high budgets (below €9 or above €100 per capita) were predominantly spent in the general population. Moderate budgets were mostly spent in diabetes patients.
Major health gains can be realized efficiently by offering prevention to both the general and the diabetic population. However, a priori setting a specific distribution of resources is suboptimal. Resource allocation models allow accounting for capacity constraints and program size in addition to efficiency.
糖尿病会增加心血管并发症的风险，患者可以从中受益于预防措施。这种预防措施也适用于普通人群。问题是，哪种策略更好：针对普通人群还是糖尿病患者？
我们开发了一个数学规划模型，以计算以下干预措施在荷兰人群中的最佳分配：戒烟支持、饮食和运动以减轻超重、他汀类药物以及降低血压的药物。结果是总终身医疗保健成本和 QALY。我们改变了预算规模，并评估了在普通人群和糖尿病患者之间分配资源的情况。
全面实施所有干预措施可获得 56 万个 QALY，人均成本为 640 欧元，平均每 QALY 约为 12900 欧元。这些 QALY 增益的绝大部分可以在增量成本低于 20,000 欧元/QALY 的情况下获得。低或高预算（人均低于 9 欧元或高于 100 欧元）主要用于普通人群。中等预算主要用于糖尿病患者。
通过向普通人群和糖尿病患者提供预防措施，可以高效地实现重大健康收益。但是，预先设定特定的资源分配是次优的。资源分配模型除了考虑效率之外，还可以考虑能力限制和项目规模。
